Keeping people healthy through consistent first point of contact
The Situation
People (clients, the population) were going to the wrong part of the health service. They either didn’t go until they were really sick, meaning they suffered loss of quality of life, and the only appropriate care was the most expensive (emergency admission to hospital), or they visited their GP up to 6 times per month because they needed someone to talk to. Meanwhile a whole lot of charities were being starved of funds because they didn’t have anyone using their services.
The Task
As Chief Executive of the GP Federation, my responsibility to the GPs was to get them home on Sunday afternoons instead of catching up with paperwork. I needed to reduce their workload so they only did what nobody else could do, and I needed to join up all the different possible services on offer and point people at the most appropriate service for their need. Part of the challenge was that nobody had time to try anything new, and there were old demarkation lines which would have to be crossed to succeed.
The Action / Approach
I started with the Local Authority – both to find out how much was already catalogued about the different charities/ community services, and who needed to be involved. To get rapid results, I started a “coalition of the willing” and began training Doctors receptionists to talk to the people they identified who could beenfit from help, at the same time rolling out a public engagement programme (including publicity such as discussion groups and leaflets) to make this change palatable to the general public. Our coalition did what we could with the willing teams, and as the nes came out, other teams joined in so the solution became more widely used.
The Result
Out of the population of 218,000, within 3 months 200,000 were able to/encouraged to speak to a Primary Care Navigator (PCN) about the non-medical issues that they were previously taking to a doctor. Some looked like medical issues (such as anxiety or depression, physical pain) but the GPs quickly realised that with a PCN available, they could solve it without pharmacology – by sending the person to a social group or an activity group. Demand on the GPs started to reduce because people were getting a much better match for their need by spending 3 hours per week with a walking group, than by 10 minutes with GP no matter how expert the GP was at listening.
That’s when it started expanding. The local authority sent their library and leisure services receptionists along to our training courses, and charities began to do the same, so no matter what the first point of contact for a member of the population, they got consistent and accurate advice. People were told “you need to see a GP” when they’d been avoiding it because they didn’t want to think they were sick.
Quality of Life improved, hospital emergency visits reduced, and we expect as it goes on that the bills for both NHS and local authority care will reduce – perhaps a 100 times return on investment.
